Demystifying Content Analysis

Building an HIV Learning Health Care Community for Youth in Florida: Opportunities and Challenges

In Florida, 33% of new HIV infections among men and 21% of new infections among women are among those younger than 29 years of age. We describe the development of a Learning Health Care Community for youth (Y-LHCC) in Orange County, FL. Its core implementation team (iTeam) was composed of representatives from community agencies and academics, whose work was informed by data from the Florida Department of Health (FDOH) and regional research, in-depth interviews (IDIs) with agency representatives, and a pilot implementation of Tailored Motivational Interviewing (TMI) to improve service provision. IDIs revealed limited programming specifically for youth, significant structural challenges providing them with PrEP, and differences in use of evidence-based behavioral interventions to improve HIV services. FDOH provided data on new HIV infections, linkage to care, viral suppression, and PrEP coverage, however, limitations such as minimal data on PrEP referrals and use, agency level data, and inability to generate data quarterly (which would facilitate program improvement) were encountered. Thirty staff members from five agencies serving youth in Orange County participated in TMI training. About half the agency staff (n = 16) completed at least three of the four online training sessions. MI skills improved from pre- (n = 28; M = 1.96) to post TMI training (n = 11; M = 2.48, SD = 0.57); (t(37) = - 3.14, p = 0.0033). The iTeam held seven remote meetings and two in-person half-day meetings at the end of the study, during which they reassessed areas of focus for improving youth services. They also reiterated their commitment to continuing to meet beyond the study period and to engage other agencies in the newly established coalition. Findings highlight the potential of creating a Y-LHCC in Florida as well as some of the challenges that will need to be overcome to achieve ending the HIV Epidemic goals for young people in the region.

What methods are used to examine representation of mental ill-health on social media? A systematic review

There has been an increasing number of papers which explore the representation of mental health on social media using various social media platforms and methodologies. It is timely to review methodologies employed in this growing body of research in order to understand their strengths and weaknesses. This systematic literature review provides a comprehensive overview and evaluation of the methods used to investigate the representation of mental ill-health on social media, shedding light on the current state of this field. Seven databases were searched with keywords related to social media, mental health, and aspects of representation (e.g., trivialisation or stigma). Of the 36 studies which met inclusion criteria, the most frequently selected social media platforms for data collection were Twitter (n = 22, 61.1%), Sina Weibo (n = 5, 13.9%) and YouTube (n = 4, 11.1%). The vast majority of studies analysed social media data using manual content analysis (n = 24, 66.7%), with limited studies employing more contemporary data analysis techniques, such as machine learning (n = 5, 13.9%). Few studies analysed visual data (n = 7, 19.4%). To enable a more complete understanding of mental ill-health representation on social media, further research is needed focussing on popular and influential image and video-based platforms, moving beyond text-based data like Twitter. Future research in this field should also employ a combination of both manual and computer-assisted approaches for analysis.

Culinary Medicine or Culinary Nutrition? Defining Terms for Use in Education and Practice

Examination of how terms such as culinary nutrition, culinary nutrition science, culinary medicine, culinary nutrition professional, culinary nutrition intervention, culinary nutrition activity, and culinary nutrition competency are used in practice, and the creation of consensus definitions will promote the consistent use of these terms across work areas and disciplines. Thirty leading practitioners, academics, and researchers in the fields of food and nutrition across Australia, the United States, Canada, United Kingdom, Europe, and Asia were approached by investigators via email to submit definitions of key terms using a Qualtrics survey link. Further participants were reached through snowball recruitment. Initial emails were sent in October and November 2021 with subsequent reminders between November 2021 and March 2022. Two researchers undertook content analysis of the text answers for each of the terms and generated definitions for discussion and consensus. Thirty-seven participants commenced the survey and twenty-three submitted one or more definitions. Agreed definitions fell into two categories: practice concepts and practitioners. Further discussion amongst investigators led to the creation of a visual map to demonstrate the interrelationship of terms. Culinary nutrition science underpins, and interprofessional collaboration characterizes practice in this area, however, further work is needed to define competencies and model best practice.

The role of provincial health administration in supporting district health management teams in the Democratic Republic of Congo: eliciting an initial programme theory of a realist evaluation

BACKGROUND

In 2006, the Ministry of Health in the Democratic Republic of Congo designed a strategy to strengthen the health system by developing health districts. This strategy included a reform of the provincial health administration to provide effective technical support to district health management teams in terms of leadership and management. The provincial health teams were set up in 2014, but few studies have been done on how, for whom, and under what circumstances their support to the districts works. We report on the development of an initial programme theory that is the first step of a realist evaluation seeking to address this knowledge gap.

METHODS

To inform the initial programme theory, we collected data through a scoping review of primary studies on leadership or management capacity building of district health managers in sub-Saharan Africa, a review of policy documents and interviews with the programme designers. We then conducted a two-step data analysis: first, identification of intervention features, context, actors, mechanisms and outcomes through thematic content analysis, and second, formulation of intervention-context-actor-mechanism-outcome (ICAMO) configurations using a retroductive approach.

RESULTS

We identified six ICAMO configurations explaining how effective technical support (i.e. personalised, problem-solving centred and reflection-stimulating) may improve the competencies of the members of district health management teams by activating a series of mechanisms (including positive perceived relevance of the support, positive perceived credibility of provincial health administration staff, trust in provincial health administration staff, psychological safety, reflexivity, self-efficacy and perceived autonomy) under specific contextual conditions (including enabling learning environment, integration of vertical programmes, competent public health administration staff, optimal decision space, supportive work conditions, availability of resources and absence of negative political influences).

CONCLUSIONS

We identified initial ICAMO configurations that explain how provincial health administration technical support for district health management teams is expected to work, for whom and under what conditions. These ICAMO configurations will be tested in subsequent empirical studies.

Introducing a Smart Toy in Eating Disorder Treatment: A Pilot Study

Individuals with eating disorders (EDs) often encounter challenges related to body image, emotional, and sensory difficulties during nutritional rehabilitation. To address these challenges, a novel technology-enabled smart toy, Purrble, designed for immediate assistance in emotion regulation, is being explored. A mixed-method approach involving workshops, diaries, and focus groups was employed to examine the feasibility of Purrble as a therapeutic tool and its impact on participants' daily routines, sensory experiences, and emotional states. The study results demonstrate the engagement and acceptability of this device. Qualitative analysis revealed that participants independently used and integrated Purrble into their emotional and sensory regulation practices. These pilot results support the potential for a shift in the delivery of adjunct therapeutic tools through technology, particularly for ED patients with complex presentations. Future research is necessary to further explore the psychological benefits of this intervention.

Presence of the partner in the operating room during a category 1 cesarean section: a prospective explorative study

BACKGROUND

Little information exists regarding attitudes related to the presence of the partner in the operation room (OR) during category 1 emergency cesarean section (cat. 1 CS). We investigated how cat. 1 CS under general anesthesia is experienced, both by partners present in the OR and those not.

METHODS

An explorative prospective cohort trial, with qualitative elements, involving all cat. 1 CS in 2022 in two hospitals. At site 1 the partner was present in the OR during cat. 1 CS, whereas at site 2 the partner was not. Parents and staff answered questionnaires following each cat. 1 CS and semi-structured interviews with partners were held three months after surgery. Qualitative data were analyzed using content analysis. The primary outcome was the partner's answer to the question: "Would you have preferred not being present/being present in the OR?" respectively.

RESULTS

Seventeen and eight cat. 1 CS occurred at each site respectively. All parents agreed to participate. No partners in site 1 would have preferred to wait outside, and all evaluated the experience very positively. Partners at site 2 also evaluated not being present positively. Overarching themes from the qualitative analysis were "Being the family witness" and "Experience of being the partner". Mothers and staff from site 1 were very positive about their partners' presence.

CONCLUSION

Partners present in the OR during cat. 1 CS under general anesthesia evaluated this very positively. Most partners, who had not been present in the OR, also evaluated this positively. No partners had post-traumatic stress.

Practices and perceptions of strength and conditioning training in female golf: A cross-sectional survey study of high-level amateur players

This study aims to ascertain an in-depth understanding of current practices and perceptions of S&C training in high-level amateur female golfers. A cross-sectional, explorative survey study was constructed which asked questions relating to four key areas: i) general participant information, ii) current strength and conditioning (S&C) practices, iii) the perceived influence of S&C training on golf performance, and iv) knowledge and awareness of S&C. Results showed that the majority of female players had participated in some form of S&C training in the past, with the majority believing that clubhead speed and carry distance were the primary golfing metrics which could be positively impacted. More specifically, 91-97% of the players "Strongly agreed" or "Agreed" that the key physical characteristics for golf were strength and power for the lower and upper body, and flexibility. Interestingly, 58% of the players believed that S&C training should mimic the movement of the golf swing, which based off current evidence, is not how drive metrics and ultimately shots gained, can be maximised. This survey study provides useful information relating to the practices and perceptions of S&C training in high-level female amateur players and areas where education may be able to further advance player understanding of physical preparation.

Mixed Methods Evaluation of Satisfaction with Two Culturally Tailored Substance use Prevention Programs for American Indian/Alaska Native Emerging Adults

American Indian/Alaska Native (AI/AN) communities are disproportionately affected by the opioid epidemic. AI/AN emerging adults (ages 18-25) in urban areas are at particularly high risk, with the overdose death rate among urban-dwelling AI/AN people 1.4 times higher than rural-dwelling AI/AN people. Despite these challenges, there are no evidence-based culturally tailored prevention or intervention programs to address opioid, alcohol and other drug use among urban AI/AN emerging adults. This study focused on understanding AI/AN emerging adults' experiences with two culturally tailored programs addressing opioid, cannabis, and alcohol use as part of the randomized controlled trial for Traditions and Connections for Urban Native Americans (TACUNA) in order to enhance feasibility of this intervention. Using a convergent mixed methods design at 3-month follow-up, we collected satisfaction and experience ratings and written narratives (total n = 162; intervention n = 77; control n = 85) from a sample of urban-dwelling AI/AN emerging adults who participated in both programs. We analyzed data through simultaneous examination of qualitative and quantitative data. The quantitative ratings show that both programs were rated highly. The qualitative data contextualized these ratings, illustrating pathways through which specific components were perceived to cause desired or observed behavioral change in participants. Among the elements that mattered most to these participants were the convenience of the virtual format, having a comfortable and safe space to share personal stories, and learning new information about their social networks. Negative comments focused on workshop length and inconvenient scheduling. This is one of the first studies to explore participant satisfaction and experience with culturally tailored substance use programming among a historically marginalized and understudied population. It is important to consider the voices of urban-dwelling AI/AN people in program development because hidden factors, such as limited financial resources, limited time, and misalignment with cultural values may prevent existing programs from being feasible.

Analyzing Patient-Provided Responses to Improve Collection of Health Equity Data Elements

Self-report is purported to be the gold standard for collecting demographic information. Many entry forms include a free-text "write-in" option in addition to structured responses. Balancing the flexibility of free-text with the value of collecting data in a structured format is a challenge if the data are to be useful for measuring and mitigating health disparities. While much work has been done to improve collection of race and ethnicity information, how to best collect data related to sexual and gender minority status and military veteran status has been less commonly studied. We analyzed 3,381 patient-provided free-text responses collected via a patient portal for gender identity, sexual orientation, pronouns, and veteran experiences. We identified common responses to better understand our patient population and help improve future iterations of data collection tools.

Nurses' challenges for disaster response: a qualitative study

BACKGROUND

Healthcare providers, particularly nurses, play a critical role in mitigating the impact of disasters on victims and the healthcare system. However, nurses face unique challenges in disasters that may not experience in their daily practice, which can make it harder for them to deal with disasters efficiently. This study aimed to investigate the challenges faced by nurses for disaster response.

METHODS

A qualitative content analysis approach was used in this study. Purposeful sampling was used to select 24 nurses working in the emergency departments of hospitals in Kerman, southeastern Iran. Data were collected through semi-structured interviews and analyzed using MAXQDA10. The conventional content analysis method proposed by Graneheim and Lundman was used to analyze the data.

RESULTS

The analysis of the findings resulted in one major category, insufficient ability of nurses to respond to disasters, and five subcategories: diverse nursing conditions during disasters, inappropriate interactive platform during disasters, the presence of obstacles to teamwork, lack of platform for nurses to acquire adequate disaster risk management competence, and moral tension in complex disaster situations.

CONCLUSIONS

Determining the challenges that nurses face during disasters is essential for improving disaster response efforts, promoting disaster preparedness, ensuring appropriate care for patients, and reducing emotional fatigue among nurses. Finally, nursing leaders, healthcare policymakers and governments should use these findings to better support the nursing workforce in disasters.

Perceptions and needs of an outpatient palliative care team regarding digital care conferences in palliative care: a mixed-method online survey

BACKGROUND

Telemedicine in palliative care (PC) is increasingly being used, especially in outpatient settings with large geographic distances. Its proven benefits include improved communication, coordination quality and time savings. However, the effect on symptom control is less evident. Whether these benefits apply to the Swiss setting and the needs of healthcare professionals (HCPs) is unknown.

OBJECTIVES

To identify the perceptions and needs of healthcare professionals (nurses and physicians) regarding telemedicine (generally and specifically for care conferences) in a Swiss outpatient palliative care network.

METHODS

We conducted a cross-sectional, mixed-method online survey with purposefully sampled healthcare professionals from an outpatient palliative care team as baseline data during the planning phase of a quality improvement project (digital care conferences).

FINDINGS/RESULTS

Of the 251 HCPs approached, 66 responded, including nurses (n = 37) and physicians (n = 29), with an overall response rate of 26.6%. These were distributed into two groups: general palliative care HCPs (n = 48, return rate 21.3%) and specialised palliative care HCPs (n = 18, return rate 69.2%). Generally, telemedicine was perceived as useful. Potential easy access to other HCPs and hence improved communication and coordination were perceived as advantages. Barriers included a lack of acceptance and physical contact, unsolved questions about potential data breaches and technical obstacles. Regarding digital care conferences, the perceived acceptance and feasibility were good; preferred participants were the specialised palliative care HCPs (nurses and physicians), primary physicians and home care nurses, as well as the leadership of a nurse. The needs of the HCPs were as follows: (a) clear and efficient planning, (b) usability and security and (c) visual contact with the patient.

CONCLUSION

Digital care conferences are perceived as a feasible and useful tool by healthcare professionals in a local palliative care network in Switzerland. A pilot phase will be the next step towards systematic integration of this telemedicine modality into outpatient palliative care.

Maintaining autonomy: How older persons with chronic conditions and their significant others interpret, navigate, and overcome everyday difficulties

BACKGROUND

The vast majority of older adults live in their own homes. Many of them live with chronic conditions that lead to activity limitations and participation restrictions. To support them adequately, we need to better understand how they cope with everyday difficulties.

AIM

To identify and examine difficulties in everyday life older people with chronic conditions who live in private homes face and how they and their significant others interpret, navigate, and overcome these difficulties.

MATERIAL AND METHODS

We conducted a focus group interview with 10 participants including eight older adults with chronic conditions and two of their significant others. We then transcribed the interviews verbatim and thematically analysed them.

RESULTS

We generated the three closely interrelated themes struggling not to lose control, a shifting balance between resources and environmental challenges, and negotiating independence and interdependence. Participants interpreted the difficulties they faced as multicausal. Their main goal was maintaining autonomy, agency, and a positive identity. They employed individual, creative strategies to achieve these goals.

CONCLUSIONS

Older persons with chronic conditions prioritise autonomy and agency in order to maintain a positive identity.

SIGNIFICANCE

Interventions to support older persons with chronic conditions should centre their priorities and build on their creativity.

Qualitative Analysis of Pre and Postpromotion/Tenure Review Processes Employed by US Pharmacy Schools

OBJECTIVE

Policies related to prepromotion/tenure reviews and postpromotion/tenure reviews are critical to faculty advancement and retention. The objective of this study is to describe the utilization, timing, and application of such policies as described within promotion and/or tenure documents from US colleges/schools of pharmacy.

METHODS

PT documents were collected from internet searches and/or contact with administrators at each institution. Qualitative content analysis was used to systematically review policies related to pre and postpromotion/tenure reviews. Policies were reviewed for required vs optional status, timing, possible outcomes, and other characteristics.

RESULTS

PT documents were analyzed from 121 (85%) colleges/schools. Of these, 26% included policies for prepromotion review of nontenure-track faculty, while 45% included pretenure reviews for tenure-track faculty. The majority of prereviews were required (65% and 91%, respectively) and conducted after 3 years in rank on average. Only 22 (18%) included postpromotion/tenure reviews, with most (17, 77%) conducting reviews after a prespecified time in advanced rank (mean 3.9 years). Potential negative consequences of postpromotion/tenure reviews were more frequently described than potential rewards.

CONCLUSION

This analysis of promotion and/or tenure documents revealed that pre/posttenure reviews were more commonly employed than pre/postpromotion reviews. Documents most frequently described potential negative consequences that may result from unsatisfactory postpromotion/tenure reviews. Academic leaders should consider the implications of these trends within their own institutions and how their own policies may be improved to create clearly articulated, fair, and parallel processes for both tenure-track and nontenure-track faculty.

An accelerated dispensing course for grad entry students - Can we teach dispensing skills over a day?

BACKGROUND AND PURPOSE

This study aimed to evaluate an accelerated dispensing course for graduate entry (GE) pharmacy students with prior science-related degrees to join undergraduate (UG) students in year three of the Monash Pharmacy degree.

EDUCATIONAL ACTIVITY AND SETTING

A one day accelerated dispensing course using MyDispense software was delivered to 59 GE students. The accelerated dispensing course was identical to the standard three-week dispensing course delivered to UG students. The same assessment of dispensing skills was conducted after course completion for both UG and GE students and included dispensing four prescriptions of varying difficulty. The assessment scores of the UG and GE students were compared. Perception data from the accelerated course were also collected.

FINDINGS

The accelerated dispensing curriculum was well received by students. They found the simulation relevant to practice, easy to navigate, and helpful for preparing them for assessment. Overall, 5.1% of GE students failed the assessment, which was lower than the 32.6% failure rate in the UG cohort. Comparison of assessment grades between UG and GE students showed no notable disadvantage to attainment of learning outcomes with the accelerated curriculum. However, UG students were more likely to provide unsafe instructions compared to GE students in their labeling for three out of four prescriptions.

SUMMARY

An accelerated dispensing curriculum can be effectively delivered to mature learners with a prior science-related degree as no notable deficiencies were identified when comparing the assessment results of GE students against UG students when both student cohorts undertook the same dispensing assessment.

Mitigating the effects of climate change in children's outdoor play environments

BACKGROUND

For many children, public playgrounds represent environments that are playful and important in developing good health. Without efforts to facilitate climate change adaptation of outdoor playgrounds there may be a negative impact on children's health and well-being.

AIM

With a special focus on play value, to explore the reasoning and described strategies among professionals responsible for development, planning and solutions concerning outdoor playgrounds in the context of climate change.

MATERIALS AND METHODS

Eight semi-structured interviews were held with purposefully selected interviewees. Analysis was conducted with manifest content analysis.

RESULTS

Four themes with supporting categories; 1: a new design paradigm for outdoor play environments, 2: a need for updated regulation- and security guidelines for outdoor play environments, 3: nature-based play environments are more climate change resilient, and 4: maintenance and construction of nature-based outdoor play environments. The findings showed an overall awareness and a will to use innovative and nature-based strategies and planning to deal with climate change implications for outdoor play environments.

CONCLUSIONS AND SIGNIFICANCE

The findings suggest that the strategies employed lean towards implementation of increased ecosystem services and natural elements. Ensuring strengthened resilience against hazardous climate change effects may positively facilitate diverse play activities with high play value.

Time to Rethink Intended Learning Outcomes for Sustainable Development? A Qualitative Exploration and Reflection of Course Syllabuses in Swedish Undergraduate Physiotherapy Education

OBJECTIVE

Several calls to action for the implementation of education for sustainable development in health profession education have been put forth during the last few years. The aim was therefore to explore and describe sustainability-focused intended learning outcomes (SD-ILOs) in curricula of undergraduate physiotherapy education in Sweden.

METHODS

Using a deductive, descriptive, and qualitative approach, SD-ILOs in programs (n = 8) and course syllabuses (n = 143) from eight higher education institutions providing physiotherapy undergraduate education in Sweden were analyzed. SD-ILOs were described based on the subject content or condition, level of cognitive processes, sustainability learning dimensions, and key sustainability competencies.

RESULTS

Six of the eight physiotherapy programs provided course syllabuses with SD-ILOs. However, only 3% (n = 36) of all ILOs were sustainability-focused. A larger part of the SD-ILOs, 78% (n = 28) was described within the cognitive dimension of learning, and 80% (n = 27) were linked to either the cognitive process 'understanding' or 'analyzing'. The most frequently identified key competency in the SD-ILOs was 'systems-thinking' n = 10 (28%), and 30% (n = 11) lacked key competency.

CONCLUSION

There is an urgent need for rapid initiatives to enhance sustainable development education in Swedish undergraduate physiotherapy education. Pedagogical approaches that cover not only cognitive dimensions of learning for sustainable development but also socio-emotional and behavioral dimensions, as well as more complex cognitive learning processes must also be developed. The current lack of key sustainability competencies further emphasizes the necessity to enrich physiotherapy curricula with action-oriented learning to develop powerful future sustainability agency within healthcare and the public health arena.

What Does Men's Health Education Look Like in Australian University Health Curricula? A Formative Evaluation and Future Enhancement Opportunities

OBJECTIVES

Developing the capacity of the health system, and the practitioners within it, to provide quality gender responsive care to men and boys remains critical to advancing men's health, and reducing health inequities amongst men. The aim for this study was to undertake a formative evaluation of Australian university health curricula for men's health content and scope the opportunities for future enhancement.

METHODS

A two-stage evaluation first involved a review of online course information for a sample of medicine (n = 10), nursing (n = 10), pharmacy (n = 10), clinical psychology (n = 10), social work (n = 12) and public health (n = 15) university curricula for men's health and gender content and opportunities for curricula enhancement. Secondly, university staff completed a survey on the coverage of men's health in their course(s), and receptivity, barriers and facilitators to curricula enhancement.

RESULTS

The curricula review found no dedicated men's health courses, and men's health was referenced in the information for 10 of 1246 courses (0.8%) in 8 of 67 curricula. Gender was rarely referenced in course information, particularly for the disciplines of medicine, nursing, pharmacy, and clinical psychology. There was an average of 16 enhancement opportunities per curricula with 40% relating to communicating and engaging with men within healthcare. Seventy staff from 25 universities and all target disciplines validated the curricula review findings of limited dedicated men's health content. Eighty-three percent were receptive to curricula enhancement, facilitated by content integration into existing courses.

CONCLUSION

This review provides clear evidence that there are gaps, opportunities, and educator receptiveness for improving and implementing content regarding men's health education and gender responsive care in Australian university health curricula.

Knowledge, Beliefs, and Cultural Practices of Sexual and Reproductive Health Among Afghan Refugee Women in Türkiye

INTRODUCTION

Limited research on experiences of women, who constitute a double vulnerable group in both women and refugee status, regarding sexual and reproductive health. The purpose of this study is to examine the knowledge, beliefs, and cultural practices of Afghan women living in Türkiye regarding sexual and reproductive health.

METHOD

This descriptive phenomenological study was conducted with 18 Afghan refugee women. In-depth, semi-structured interviews were conducted to collect data.

RESULTS

Four themes emerged from interviews: cultural practices and beliefs related to pregnancy and postpartum, use of contraceptive methods, gender-based violence, and access to health services.

CONCLUSIONS

Afghan women have different cultural practices regarding prenatal, pregnancy, and postpartum and lack of knowledge about sexual and reproductive health. Considering individual differences in sexual and reproductive health, providing sensitive, supportive, and informative services is recommended.

A qualitative study to explore student learning and development of interprofessional collaboration during an online interprofessional education intervention

Interprofessional education (IPE) during undergraduate education and training has been found to improve collaboration between health care students. This supports interprofessional working in clinical practice to enhance patient safety and care delivery.Undergraduate students from pharmacy and medical programmes worked online in pairs to review notes of hospital patients due to be discharged. Students were tasked to complete a discharge letter and undertake an online consultation with a simulated patient prior to discharge. Online interactions were recorded and assessed using a validated tool to measure interprofessional professionalism. Students undertook this intervention in different pairings with different patient cases for three iterations after receiving feedback and undertaking a reflective exercise.The aim was to investigate the student learning and development that could be used to inform intervention optimisation and scale-up.Qualitative data were collected from different sources. Method triangulation was employed to develop a comprehensive understanding of the student learning and development. Data was collected from written feedback provided by the assessment team, student reflections on their performance, and from semi-structured interviews conducted with the student pairs and one to one with the assessment team. Content and thematic analysis was used to analyse these data and the Kirkpatrick/Barr evaluation model provided a framework to organise the themes.Eighteen students (nine from each professional programme) completed the study and a total of 27 IPE sessions were conducted. The assessment team completed 54 assessment tools and 31 student reflections were received (from a maximum of 36). Students were interviewed in their interprofessional pairs to yield nine interview transcripts and one interview was conducted with the assessment team.Students reported and were observed to improve in interprofessional collaboration over the three iterations following feedback and rehearsal opportunities. Longitudinal observation and assessment of student interprofessional working in changing teams provided the opportunity to capture the influence of interdependence on student performance and assessment of competence.

Explaining Iranian midwives' experiences of providing healthcare services during the COVID-19 pandemic: a qualitative study

BACKGROUND

COVID-19 has changed and challenged the way health and maternity care is provided. Midwives are among the first and most influential maternity care providers during the COVID-19 pandemic; however, there is inadequate information about their experiences in providing healthcare services, particularly in Iran. The present study was conducted to explain the midwives' experiences of providing healthcare services during the COVID-19 pandemic in Gorgan.

METHODS

The present study was conducted qualitatively through the inductive content analysis method in 2022. Data were collected through semi-structured interviews. A total of 21 individuals were selected as participants using a purposeful method and the maximum diversity strategy.

RESULTS

Data analysis led to the emergence of 377 codes, 12 subcategories, and 3 main categories, including, the laborious occupational challenges for midwives during the pandemic, identifying and creating new opportunities for the development of the midwifery profession, and the lack of perceived organizational and social support.

CONCLUSIONS

During the COVID-19 pandemic, midwives experienced various challenges in providing healthcare services, yet sacrificed themselves to perform their duties and provide quality care incessantly. The COVID-19 pandemic was a combination of laborious occupational challenges and individual and professional growth opportunities for midwives in Iran. Strong and managed organizational support is essential to overcome the crisis, maintain the workforce, and empower them to deal with future crises.

Assessing Community College Biology Student Perceptions of Being Called on in Class

Random call has been proposed as an inclusive and equitable practice that engages students in learning. However, this inclusion may come with a cost. In some contexts, students experience anxiety and distress when being called on. Recently, focus has shifted to critical components of random call that may mitigate this cost. We examined how community college (CC) students perceive being called on by addressing 1) benefits that help their learning and 2) characterizing the anxiety students experience through this practice. To do this, we surveyed students in six biology courses taught by six faculty members over six academic quarters. We analyzed survey responses from 383 unique students (520 total responses) using mixed methods. Qualitative responses were coded and consensus codes revealed that students saw benefits to being called on, including paying attention and coming prepared. Qualitative codes also revealed different types of anxiety, both distress and eustress. Analysis of Likert scale survey data revealed perceptions of increased student interaction with their peers in warm random call classes. Furthermore, warm random call may increase participation in class discussions, and it is not correlated with increased extreme anxiety. These data suggest warm random call used in smaller, community college classes, may contribute to students' positive perceptions of being called on.

Perception of self-management and glycaemic control in people with type 2 diabetes receiving insulin injection therapy: A qualitative study

AIM

The aim of this study was to explore the experience of self-management and glycaemic control in Chinese people with type 2 diabetes receiving insulin injection therapy.

METHODS

A qualitative descriptive design was adopted with individual, semi-structured interviews. Participants were selected by purposive sampling. All face-to-face interviews were conducted between December 2020 and January 2021. The interviews were audio recorded and transcribed verbatim. Content analysis was used to analyse the interview data.

RESULTS

A total of 27 participants were recruited and individually interviewed. Three themes were generated: integrating insulin injection therapy into daily self-management; experiencing uncertainty when coping with suboptimal glycaemic control; and self-management programmes for optimal diabetes control.

CONCLUSION

All of our findings increase the understanding of self-management and glycaemic control in people with T2D receiving insulin injection therapy. Healthcare professionals should recognise the unmet needs of this cohort to promote their diabetes management. Appropriate and effective self-management programmes should be developed and implemented to alleviate the negative impacts of insulin injection therapy on diabetes management with consideration of cultural and personal context.

Perceptions of Data Set Experts on Important Characteristics of Health Data Sets Ready for Machine Learning: A Qualitative Study

Importance

The lack of data quality frameworks to guide the development of artificial intelligence (AI)-ready data sets limits their usefulness for machine learning (ML) research in health care and hinders the diagnostic excellence of developed clinical AI applications for patient care.

Objective

To discern what constitutes high-quality and useful data sets for health and biomedical ML research purposes according to subject matter experts.

Design, Setting, and Participants

This qualitative study interviewed data set experts, particularly those who are creators and ML researchers. Semistructured interviews were conducted in English and remotely through a secure video conferencing platform between August 23, 2022, and January 5, 2023. A total of 93 experts were invited to participate. Twenty experts were enrolled and interviewed. Using purposive sampling, experts were affiliated with a diverse representation of 16 health data sets/databases across organizational sectors. Content analysis was used to evaluate survey information and thematic analysis was used to analyze interview data.

Main Outcomes and Measures

Data set experts' perceptions on what makes data sets AI ready.

Results

Participants included 20 data set experts (11 [55%] men; mean [SD] age, 42 [11] years), of whom all were health data set creators, and 18 of the 20 were also ML researchers. Themes (3 main and 11 subthemes) were identified and integrated into an AI-readiness framework to show their association within the health data ecosystem. Participants partially determined the AI readiness of data sets using priority appraisal elements of accuracy, completeness, consistency, and fitness. Ethical acquisition and societal impact emerged as appraisal considerations in that participant samples have not been described to date in prior data quality frameworks. Factors that drive creation of high-quality health data sets and mitigate risks associated with data reuse in ML research were also relevant to AI readiness. The state of data availability, data quality standards, documentation, team science, and incentivization were associated with elements of AI readiness and the overall perception of data set usefulness.

Conclusions and Relevance

In this qualitative study of data set experts, participants contributed to the development of a grounded framework for AI data set quality. Data set AI readiness required the concerted appraisal of many elements and the balancing of transparency and ethical reflection against pragmatic constraints. The movement toward more reliable, relevant, and ethical AI and ML applications for patient care will inevitably require strategic updates to data set creation practices.

An analysis of the barriers and enablers to implementing the Safewards model within inpatient mental health services

Mental health inpatient units can provide a sanctuary for people to recover from mental illness. To support a therapeutic environment, the safety and well-being of service users and staff need protection through reduced conflict and containment rates. The Safewards model identifies 10 interventions to prevent conflict and containment. This paper aims to present barriers and enablers to implementing Safewards by analysing current literature on the Safewards model. It will also compare the Safewards model to New Zealand's Six Core Strategies. In a systematic search of 12 electronic databases following the PRISMA flow chart, 22 primary studies were included in this analysis. JBI tools were used for quality appraisal and deductive content analysis was used to organize and interpret data. Four categories were identified: (a) designing the Safewards interventions and implementation; (b) staff participation and perception of Safewards; (c) healthcare system influences on Safewards implementation; (d) service user participation and perception of Safewards. To support successful Safewards implementation in future practice, this review recommends that Safewards implementation is enabled through robust design of the Safewards interventions and implementation methods; staff participation and positive perception of the Safewards model; a resourced healthcare system that prioritizes Safewards implementation; service user awareness and participation in Safewards interventions. Interactionist perspectives may support the implementation of Safewards. This analysis is limited by research settings mostly being inpatient adult services and inadequate capturing of the service user voice. An ongoing review of barriers and enablers is important for supporting future Safewards implementation.

Parents' knowledge of the 2019 Canada's Food Guide recommendations

Little is known about Canadians' knowledge of the 2019 Canada's Food Guide (CFG) recommendations. Using cross-sectional survey data from the Guelph Family Health Study, our brief communication aimed to explore parents' knowledge of the 2019 CFG recommendations through descriptive statistics and content analysis. Among a sample of 122 parents, we found that parents had a general understanding of the 2019 CFG's recommendations but poor knowledge of specific details of the recommendations, such as the names of the three food groups and which foods contain unhealthy fats.

Preventable deaths involving opioids in England and Wales, 2013-2022: a systematic case series of coroners' reports

BACKGROUND

Opioid deaths have increased in England and Wales. Coroners' Prevention of Future Deaths reports (PFDs) provide important insights that may enable safer use and avert harms, yet reports implicating opioids have not been synthesized. We aimed to identify opioid-related PFDs and explore coroners' concerns to prevent future deaths.

METHODS

In this systematic case series, we screened 3897 coronial PFDs dated between 01 July 2013 and 23 February 2022, obtained by web scraping the UK's Courts and Tribunals Judiciary website. PFDs were included when an opioid was implicated in the death. Included PFDs were descriptively analysed, and content analysis was used to assess concerns reported by coroners.

RESULTS

Opioids were involved in 219 deaths reported in PFDs (5·6% of PFDs), equating to 4418 years of life lost (median 33 years/person). Morphine (29%), methadone (23%) and diamorphine (16%) were the most common implicated opioids. Coroners most frequently raised concerns regarding systems and protocols (52%) or safety issues (15%). These concerns were most often addressed to National Health Service (NHS) organizations (51%), but response rates were low overall (47%).

CONCLUSIONS

Opioids could be used more safely if coroners' concerns in PFDs were addressed by national organizations such as NHS bodies, government agencies and policymakers, as well as individual prescribing clinicians.

Content analysis of family physician plan using social marketing approach: Qualitative- document analysis

BACKGROUND

The family physician plan formed at the heart of the health system can play a vital role in the results and the optimal cost of resources. Social marketing is a process that uses the basics and principles of commercial marketing in the field of health to develop and implement a health plan. This study seeks to analyze the documents related to the program from the perspective of social marketing components.

MATERIALS AND METHODS

This qualitative document analysis study was conducted in 2021 by reviewing the documents and content of the texts related to family physician plan. The obtained data were analyzed by the directed content analysis method after extraction and collection.

RESULTS

The results showed the identification of social marketing components in the family physician plan. However, the two most essential parts of "insight" and "behavior theory," which address the underlying issues in an intervention, were not found in the analyzed documents and texts.

CONCLUSION

It is necessary to use a coherent and appropriate approach to revise and develop the family physician plan. To resolve the current challenges and problems of the family physician plan, the application of components and the social marketing approach that addresses all the required aspects of a health plan is a suitable model and approach.

Scenario- and discussion-based approach for teaching preclinical medical students the socio-philosophical aspects of psychiatry

BACKGROUND

This study used a scenario- and discussion-based approach to teach preclinical medical students the socio-philosophical aspects of psychiatry and qualitatively evaluated the learning outcomes in a medical humanities course in Taiwan.

METHODS

The seminar session focused on three hypothetical psychiatry cases. Students discussed the cases in groups and were guided by facilitators from multiple disciplines and professions. At the end of the semester, students submitted a narrative report comprising their reflections on the cases and discussions. The authors utilized content analysis to categorize students' narratives into three facets, namely, the philosophical, social and individual.

RESULTS

In total 163 preclinical medical students participated in the class; 150 of them mentioned the scenario-based lesson in their reports; 33.3% of these reports discussed the case at the philosophical dimension (n = 50), 45.3% at the social dimension (n = 68), and 26.6% at the individual dimension (n = 40). Four major themes emerged: (1) a psychiatric diagnosis has far-reaching consequences for an individual's life, (2) the social structure affects how patients experience psychiatric disorders, (3) students related personal experience or those of friends and family to understand psychiatric disorders, and (4) medical humanities are of particular importance in psychiatric education.

CONCLUSIONS

This study demonstrated that the scenario-based discussions led by a multidisciplinary team of facilitators can benefit medical students with limited clinical experience to contemplate the socio-philosophical aspects of psychiatry. The authors suggest that this pedagogical model during preclinical education should be encouraged.

Reasons people avoid colorectal cancer information: a mixed-methods study

OBJECTIVE

With screening, colorectal cancer can be detected when treatable, or even prevented. However, approximately one in five people tend to avoid colorectal cancer information, and avoidance is associated with being less likely to have been screened for the disease. Crucial to developing strategies to reduce information avoidance, we sought a comprehensive understanding of reasons people avoid colorectal cancer information.

METHODS AND MEASURES

In a mixed methods study, we surveyed 200 participants who varied with respect to avoidance and interviewed 15 people who tended to avoid colorectal cancer information (all aged 40-75) about reasons for avoiding.

RESULTS

In both survey and interviews, primary reasons for information avoidance were: (1) shielding from anxiety and other aversive emotion, (2) perceived information sufficiency and (3) feelings of information overload. Trait anxiety, fear of diagnosis, anticipating negative interactions with healthcare, and negative associations with screening procedures exacerbated avoidance. Participants justified information non-relevance by attributing risk to other people's characteristics such as family history, gastrointestinal symptoms, being male, or living an unhealthy lifestyle.

CONCLUSION

Novel findings include the triggering influence of trait anxiety and financial constraints on information avoidance. Also, information overload and incorrect understanding of risk factors may exacerbate perceptions of information sufficiency and avoidance.

Hospital doctors' and general practitioners' perspectives of outpatient discharge processes in Australia: an interpretive approach

BACKGROUND

Unnecessary delays in patient discharge from hospital outpatient clinics have direct consequences for timely access of new patients and the length of outpatient waiting times. The aim of this study was to gain better understanding of hospital doctors' and general practitioners' perspectives of the barriers and facilitators when discharging from hospital outpatients to general practice.

METHODS

An interpretative approach incorporating semi-structured interviews with 15 participants enabled both hospital doctors and general practitioners to give their perspectives on hospital outpatient discharge processes.

RESULTS

Participants mentioned various system problems hampering discharge from hospital outpatient clinics to general practice, such as limitations of electronic communication tools, workforce and workload challenges, the absence of agreed discharge principles, and lack of benchmark data. Hospital clinicians may keep patients under their care out of a concern about lack of follow-up and an inability to escalate timely hospital care following discharge. Some hospital clinicians may have a personal preference to provide ongoing care in the outpatient setting. Other factors mentioned were insufficient supervision of junior doctors, a patient preference to remain under hospital care, and the ease of scheduling follow-up appointments. An effective handover process requires protected time, a systematic approach, and a supportive clinical environment including user-friendly electronic communication and clinical handover tools. Several system improvements and models of care were suggested, such as agreed discharge processes, co-designed between hospitals and general practice. Recording and sharing outpatient discharge data may assist to inform and motivate hospital clinicians and support the training of junior doctors. General practitioners participating in the study were prepared to provide continuation of care but require timely clinical management plans that can be applied in the community setting. A hospital re-entry pathway providing rapid access to outpatient hospital resources after discharge could act as a safety net and may be an alternative to the standard 12-month review in hospital outpatient clinics.

CONCLUSION

Our study supports the barriers to discharge as mentioned in the literature and adds the perspectives of both hospital clinicians and general practitioners. Potential solutions were suggested including co-designed discharge policies, improved electronic communication tools and a rapid hospital review pathway following discharge.

Women's perspectives of nitrous oxide for labour and procedural analgesia: A prospective clinical audit and cross-sectional study. "It's the best thing"

PROBLEM

There is limited data regarding dose and duration of nitrous oxide use by women in peripartum care. Experiences of using nitrous in Australian settings have not previously been explored BACKGROUND: More than 1:2 women use nitrous oxide analgesia during labour and birth, despite this, there are limited published data on nitrous oxide use for labour or procedural analgesia in Australia.

AIM

To explore the use of nitrous oxide during labour and birth or procedural care.

METHODS

A two-phased sequential design was used; clinical audit (n = 183) and cross-sectional survey (n = 137) approaches supported data collection. Quantitative data were analysed using descriptive and inferential statistics, qualitative data underwent content analysis.

FINDINGS

Nitrous oxide was used by primiparous and multiparous women evenly. Duration of labour-use ranged from < 15 min (10.9%) to > 5 h (10.8%), with equal representation between > 50% concentration (43%) and < 50% (43%). At audit, 75% found nitrous useful; postpartum maternal satisfaction scores remained high, mean indicators were 75%. More multiparous women found nitrous oxide useful than primiparous (95%vs80%,p = 0.009). There was no association between perceived usefulness and whether women were in spontaneous, augmented or induced labour; regardless of concentrations reached. Three key themes described women's perspectives of physical and psycho-emotional effects and challenges.

DISCUSSION

Nitrous oxide plays an important role in the provision of analgesia during procedural or labour and birth care. Service provision, parent and professional education, and future service design will benefit from these novel findings confirming the utility and acceptability of nitrous oxide use in contemporary maternity care.

A qualitative inquiry of parents of extremely picky eaters: Experiences, strategies and future directions

BACKGROUND/AIM

Picky eating is a common childhood phenomenon in younger children, impacting family relationships and mealtimes. Limited qualitative studies have explored parents' experiences of parenting an extremely picky eater. This study aimed to address this gap.

METHODS

This exploratory qualitative research design included participants who were Australian-based parents (n = 10) of children aged 2-6 years with a minimum picky eating score of 3.33, indicating extreme picky eating, on the Food Fussiness subscale of the Child Eating Behavior Questionnaire (CEBQ). Parents were interviewed online via Zoom using semi-structured interviews focused on their experiences of having a child who is a picky eater. Reflexive thematic analysis was used to analyze the data.

RESULTS

Five themes were identified: 1: The picky eating journey for parents. 2: Picky eating impacts families and mealtimes. 3: Parents have attempted multiple strategies to manage picky eating. 4: Emotions associated with parenting an extremely picky eater. 5: Parents of extremely picky eaters have a positive outlook for the future.

CONCLUSION

This qualitative study demonstrates that parents' experiences of parenting an extremely picky eater are varied. Parents desire health professionals who listen to their concerns and provide evidence-based knowledge around parent feeding practices to positively impact picky eating.

Development and testing of the Midwifery Perceptions and Assessment of Clinical Teaching (MidPaACT) tool

OBJECTIVE

Develop and test a tool to measure midwives' perceptions of their role in preceptoring midwifery students.

DESIGN

A multi method exploratory study design was used.

POPULATION

Preceptor midwives from three maternity units in south-east Queensland Australia.

METHODS

A three-phase process was used: item generation; expert review; psychometric testing including content analysis of qualitative responses. The survey was online or paper-based and included demographic details, the Clinical Preceptor Experience Evaluation Tool (CPEET) role subscale and draft tool. A focus group discussion explored the open-ended responses.

FINDINGS

A large sample of preceptors (n = 164, 64.2 % response rate) participated. Factor analysis revealed a two-factor structure with 24 items accounting for 40.2 % of variance. The mean total score of the Midwifery Perceptions and Assessment of Clinical Teaching (MidPaACT) tool was 103.31 (SD = 9.47). The scale was reliable (Cronbach's alpha 0.89) and valid. Test-retest reliability showed moderate to excellent temporal stability across the scale and subscales. Measures of concurrent validity showed little agreement with the CPEET tool. Qualitative analysis revealed the way midwives were taught as students had a powerful influence on their approach to teaching in practice.

CONCLUSION

This tool is specifically designed to assess midwifery preceptors' perceptions of their role in student learning in practice. Psychometric testing of the MidPaACT tool confirms its reliability and validity.

IMPLICATIONS FOR PRACTICE

Midwifery preceptors are a key influence on the development of students' capability as a midwife. Midwives' perceptions of their proficiency in student learning are under-reported. The MidPaACT tool provides a reliable and valid means of measuring preceptors' perceptions and identifying areas for future educational and workforce improvement.

Digital mental health interventions: A narrative review of what is important from the perspective of LGBTQIA+ people

OBJECTIVES

Digital mental health interventions are a promising therapeutic modality to provide psychological support to LGBTQIA+ (lesbian, gay, bisexual, trans, Queer, intersex, asexual, plus other gender, sexual, and romantic minority identities) people. The aim of this narrative review is to explore how the LGBTQIA+ community has been engaged in the design of digital mental health interventions, how content has been tailored to the LGBTQIA+ community, and features identified as important by LGBTQIA+ participants.

METHODS

A total of 33 studies were included in this review from a larger yield of 1933 identified from systematic searches of five databases (PsycINFO, PubMed, Scopus, CINAHAL, and Medline). Data were analyzed narratively and using content analysis.

RESULTS

Only half of the studies reported engaging the LGBTQIA+ community in intervention designs. Interventions have been tailored in a variety of ways to support LGBTQIA+ individuals-such as through affirming imagery, recruitment through LGBTQIA+ networks, and designing content to focus specifically on LGBTQIA+ issues. A range of features were identified as important for participants, namely how content was tailored to LGBTQIA+ experiences, providing connection to community, and links to other relevant LGBTQIA+ resources. While not a primary aim, results also showed that a wide range of digital modalities can significantly improve a range of mental health problems.

CONCLUSION

Digital interventions are an acceptable and effective form of therapeutic intervention, but future research needs to focus on meaningful engagement of community members to inform design and implementation.

Quantitative content analysis of Freedom of Information requests examining the extent and variations of tools and training for conducting suicide risk assessments in NHS Trusts across England

OBJECTIVES

Determining the risk for suicide is a difficult endeavour. Clinical guidance in the UK explicitly advises against using risk assessment tools and scales to determine suicide risk. Based on Freedom of Information (FoI) requests made to NHS Trusts in England, this study provides an overview of suicide risk assessment tools in use, training provided in how to use such assessments, and explores implementation of suicide risk assessment guidance in practice in English NHS Trusts.

DESIGN

A cross-sectional survey of suicide risk assessment tools and training gathered via FoI requests and subjected to a content analysis.

SETTING

FoI requests were submitted to NHS Trusts across England.

RESULTS

A wide variety of suicide risk assessments tools were identified as being used in practice, with several trusts reported using more than one tool to determine suicide risk. Forty-one trusts reported using locally developed, unvalidated, tools to assess risk of suicide and 18 stated they do not use a tool. Ten trusts stated they do not train their staff in suicide risk assessment while 13 reported use of specific suicide risk assessment training. Sixty-two trusts stated they do not centrally record the number of assessments conducted or how many individuals are identified as at risk. Content analysis indicated the frequent wider assessment of risk not restricted to suicide risk.

CONCLUSIONS

There is wide variation in suicide risk assessment tools being used in practice and some lack of specific training for healthcare staff in determining suicide risk. Few trusts routinely record the number of assessments being conducted or the number of individuals identified at high risk. Implementation of specific training is necessary for the suicide risk assessment process to identify patient needs and develop therapeutic engagement. Routinely recording how many assessments are conducted is a crucial step in improving suicide prevention.

Preventable deaths involving falls in England and Wales, 2013-22: a systematic case series of coroners' reports

BACKGROUND

Falls in older people are common, leading to significant harm including death. Coroners have a duty to report cases where action should be taken to prevent future deaths, but dissemination of their findings remains poor.

OBJECTIVE

To identify preventable fall-related deaths, classify coroner concerns and explore organisational responses.

DESIGN

A retrospective systematic case series of coroners' Prevention of Future Deaths (PFD) reports, from July 2013 (inception) to November 2022.

SETTING

England and Wales.

METHODS

Reproducible data collection methods were used to web-scrape and read PFD reports. Demographic information, coroner concerns and responses from organisations were extracted and descriptive statistics used to synthesise data.

RESULTS

Five hundred and twenty-seven PFDs (12.5% of PFDs) involved a fall that contributed to death. These deaths predominantly affected older people (median 82 years) in the community (72%), with subsequent death in hospital (70.8%). A high proportion of cases experienced fractures (51.6%), major bleeding (35.9%) or head injury (38.7%). Coroners frequently raised concerns regarding falls risks assessments (20.9%), failures in communication (20.3%) and documentation issues (17.5%). Only 56.7% of PFDs received a response from organisations to whom they were addressed. Organisations tended to produce new protocols (58.5%), improve training (44.6%) and commence audits (34.3%) in response to PFDs.

CONCLUSIONS

One in eight preventable deaths in England and Wales involved a fall. Addressing concerns raised by coroners should improve falls prevention and care following falls especially for older adults, but the poor response rate may indicate that lessons are not being learned. Wider dissemination of PFD findings may help reduce preventable fall-related deaths in the future.

Perinatal depression screening in community pharmacy: Exploring pharmacists' roles, training and resource needs using content analysis

BACKGROUND

Perinatal depression (PND) screening is often recommended in primary care settings, which includes the community pharmacy setting. However, there is limited research exploring pharmacists' perspectives on their roles in screening for perinatal mental illness.

AIM

This study aimed to explore pharmacists' views of pharmacists' roles in PND screening, as well as training and resource needs for PND screening in community pharmacy settings.

METHOD

A questionnaire including three open-ended questions focusing on pharmacists' perspectives of their role in PND screening, their training, and resource needs in this area, was disseminated to pharmacists across Australia via professional organisations and social media. Each open-ended question was separately analysed by inductive content analysis. Subcategories were deductively mapped to the Theoretical Framework of Acceptability.

RESULTS

Responses (N = 149) from the first open-ended question about pharmacists' roles in PND screening resulted in three categories (PND screening in primary care settings will support the community, community pharmacy environment, and system and policy changes) and ten subcategories. Responses to question two on training needs (n = 148) were categorised as: training content, training length, and training delivery while responses about resource needs (n = 147) fell into three categories: adapting community pharmacy operating structures, pharmacist-specific resources, and consumer-specific resources.

CONCLUSION

While some pharmacists were accepting of a role in PND screening due to pharmacists' accessibility and positive relationships with consumers, others had concerns regarding whether PND screening was within pharmacists' scope of practice. Further training and resources are needed to facilitate pharmacists' roles in PND screening, referral and care.

Methods to assess ambivalence towards food and diet: a scoping review

BACKGROUND

Ambivalence towards food and diet, which favours behavioural inertia, might be a barrier to adopting healthier eating behaviours. Measuring it can help researchers to better understand its relationship with behaviour change and design interventions aimed at resolving it. In this scoping review, we map and describe methods and tools employed in studies to assess, measure or classify the ambivalence of participants towards food- and diet-related attitude objects.

METHODS

In accordance with Joanna Briggs Institute guidance for conducting scoping reviews, we retrieved peer-reviewed studies from MEDLINE, CINAHL, PsycINFO, Web of Science, FSTA and Food Science Source and preprints from PsyArXiv and MedRxiv. Two independent reviewers screened the articles. We considered for inclusion peer-reviewed studies and preprints that assessed the ambivalence of participants of any age, sex or sociodemographic group towards food and diet.

RESULTS

We included 45 studies published between 1992 and 2022, which included participants from 17 countries. Eighteen methods were employed across the included studies to assess different types of ambivalence (felt, potential or cognitive-affective), the most frequent of which were the Griffin Index, the Subjective Ambivalence Questionnaire, the MouseTracker Paradigm and the Orientation to Chocolate Questionnaire.

CONCLUSION

This scoping review identified several methods and tools to assess different types of ambivalence towards food- and diet-related objects, providing an array of options for future studies.

TF-CBT Training Augmented with a Self-Care Focus: Understanding Facilitators and Barriers to Treatment Implementation

Clinicians working with youth exposed to trauma may be at increased risk for experiencing elevated levels of stress and symptoms of secondary traumatic stress, which can negatively impact clinician wellbeing and ultimately contribute to reduced access to quality care for clients. An innovative Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) training incorporating self-care practices (i.e., Practice What You Preach; PWYP) was developed to help facilitate the implementation of TF-CBT and to enhance clinicians' coping and decrease stress. The primary purpose of this study was to determine whether the PWYP-augmented training met three Objectives: (1) increase clinicians' feelings of TF-CBT competency; (2) improve clinicians' coping abilities/reduce clinicians' stress; and (3) increase clinicians' insight into the benefits and/or challenges clients may experience in treatment. An exploratory aim was also developed to identify additional facilitators and barriers of TF-CBT implementation. The written reflections of 86 community-based clinicians who participated in the PWYP-augmented TF-CBT training were examined using qualitative methods. The majority of clinicians indicated increased feelings of competency and improved coping abilities and/or stress levels; almost half mentioned increased insight into clients' experiences. The most frequently mentioned additional facilitators were related to elements of the TF-CBT treatment model. Anxiety/self-doubt was the barrier most frequently mentioned, though all clinicians who mentioned this barrier indicated it lessened or resolved over the course of the training. Incorporating self-care strategies into trainings may serve as a facilitator for TF-CBT implementation by enhancing the competency and well-being of clinicians. The additional insights into barriers and facilitators can be used to further improve the PWYP initiative and future training and implementation efforts.

"We have to save him": a qualitative study on care transition decisions in Ontario's long-term care settings during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has contributed to a global crisis in long-term care (LTC) with devastating consequences for residents, families and health professionals. In Ontario, Canada the severity of this crisis has prompted some care partners to move residents home with them for the duration or a portion of the pandemic. This type of care transition, from LTC to home care, was highly unusual pre-pandemic and arguably suboptimal for adults with complex needs. This paper presents the findings of a qualitative study to better understand how residents, care partners, and health professionals made care transition decisions in Ontario's LTC settings during the pandemic.

METHODS

Semi-structured interviews were conducted with 32 residents, care partners and health professionals who considered, supported or pursued a care transition in a LTC setting in Ontario during the pandemic. Crisis Decision Theory was used to structure the analysis.

RESULTS

The results highlighted significant individual and group differences in how participants assessed the severity of the crisis and evaluated response options. Key factors that had an impact on decision trajectories included the individuals' emotional responses to the pandemic, personal identities and available resources.

CONCLUSIONS

The findings from this study offer novel important insights regarding how individuals and groups perceive and respond to crisis events.

"Our Community Comes First": Investigating Recruitment Ads That Represent and Appeal to Black Women for Online, HIV-Related Research Studies

BACKGROUND

Black women are underrepresented in health-related research. Consulting Black women in the creation of recruitment materials may help increase their representation in research studies, but few of these recruitment materials have been evaluated. This manuscript reports on the impact of two ads (one featuring older women and one featuring younger women) created through multiple focus group sessions with Black women. The purpose of the ads were to recruit Black women to participate in an online research study about HIV prevention and pre-exposure prophylaxis, PrEP.

MATERIALS AND METHODS

Questions about the ads were embedded in the eligibility screener for inclusion in the online parent research study. Respondents were asked which ad they saw, what they liked about it, and what about the ad piqued their interest in the study.

RESULTS

In total, 301 Black women completed the eligibility screener for the online study and answered questions pertaining to the two ads. Most participants reported seeing the ad with younger women (260/301, 86.4%). Representation of Black women (n = 70), ad design (n = 64), relevance to Black women and the Black community (n = 60), and comprehensiveness of ad content (n = 38) were the top 4 ad features respondents liked. Relevance to Black women and the Black community (n = 104) as well as ad content (n = 54) (i.e., study purpose, location, duration, images, incentive) were the top two reasons provided about ads that piqued respondent's interest in the online study.

CONCLUSION

Findings showcase how recruitment ads informed by Black women could help increase their interest and participation in research.

Investigating how the GRADE Evidence to Decision (EtD) framework is used in Clinical Guidelines: a scoping review protocol

Introduction: The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) evidence to decision (EtD) framework provides a structured and transparent approach for clinical guideline developers to use when formulating recommendations. Understanding how stakeholders use the EtD framework will inform how best to provide future training and support. This scoping review objective is to identify the key characteristics of how the GRADE EtD framework is used and identify studies on perception of use by those involved in developing clinical guidelines. Methods: JBI methodology for scoping reviews will be followed. This scoping review will consider both peer review published literature and grey literature. This will include empirical studies on the use of EtDs (including both quantitative, qualitative, and mixed methods primary research articles) and discussion papers/ commentaries on the experience of using the EtD. It will also include a random sample of publicly available populated EtDs identified from databases and repositories of GRADE guidelines. The search strategy will aim to locate both published and unpublished documents. First, we will conduct an exploratory search of MEDLINE and Embase (Elsevier), supplemented with citation analysis of included articles. Populated EtDs will be identified through searches of databases and repositories of GRADE guidelines. Two researchers will independently screen, select, and extract identified documents. Data will be presented in tables and summarized descriptively. Conclusion: This scoping review will identify the key characteristics of how the GRADE EtD framework is currently being used in clinical guidelines. Review findings can be used to inform future guidance and requirements for using GRADE EtD, as well as training on how to consider the criteria in developing recommendations. Results will be disseminated through publications in peer - reviewed journals and conference presentations. We will present our findings to relevant stakeholders via the networks of the co-author team at a one-day workshop.

Evaluation of an online research best practices training for community health workers and promotoras

Introduction

Community health workers and promotoras (CHW/Ps) have a fundamental role in facilitating research with communities. However, no national standard training exists as part of the CHW/P job role. We developed and evaluated a culturally- and linguistically tailored online research best practices course for CHW/Ps to meet this gap.

Methods

After the research best practices course was developed, we advertised the opportunity to CHW/Ps nationwide to complete the training online in English or Spanish. Following course completion, CHW/Ps received an online survey to rate their skills in community-engaged research and their perceptions of the course using Likert scales of agreement. A qualitative content analysis was conducted on open-ended response data.

Results

104 CHW/Ps completed the English or Spanish course (n = 52 for each language; mean age 42 years SD ± 12); 88% of individuals identified as female and 56% identified as Hispanic, Latino, or Spaniard. 96%-100% of respondents reported improvement in various skills. Nearly all CHW/Ps (97%) agreed the course was relevant to their work, and 96% felt the training was useful. Qualitative themes related to working more effectively as a result of training included enhanced skills, increased resources, and building bridges between communities and researchers.

Discussion

The CHW/P research best practices course was rated as useful and relevant by CHW/Ps, particularly for communicating about research with community members. This course can be a professional development resource for CHW/Ps and could serve as the foundation for a national standardized training on their role related to research best practices.

The development of a Cannabis Knowledge Assessment Tool (CKAT)

BACKGROUND

Misconceptions about the health risks of cannabis remain prevalent, indicating the need to improve public health messaging and determine the effectiveness of educational programming. Our objective was to develop a standardized questionnaire to measure knowledge about cannabis in the context of cannabis legalization.

METHODS

A Cannabis Knowledge Assessment Tool (CKAT) was created using the Delphi method. A purposive sample of healthcare professionals, policymakers, academics, patients, and students served as the content and development experts. Principal component analysis from the codes identified from open-ended feedback guided the item development. Upon completion, the CKAT was administered as a pre- and post-test in four schools (7th and 9th Grade) in Canada. The data were analysed to determine whether knowledge scores changed after participating in a cannabis education program.

RESULTS

Twenty-four experts initially participated in the Delphi process and 18 (75% retention) continued throughout. Principal component analysis identified 3 domains: 1) effects of cannabis on the individual, 2) general information about cannabis, and 3) cannabis harm reduction. The final questionnaire consisted of 16 multiple-true-false questions (64 items) and received a Flesch-Kincaid Grade Level of 6.3, and a SMOG index score of 7.6. The CKAT was completed by 132 students; seventy-three 7th grade and fifty-nine 9th grade students. The baseline mean CKAT score was 46.2 (SD:5.5), which increased to 50.7 (SD:4.6) after the cannabis educational program (p<0.05).

CONCLUSIONS

A novel tool to measure knowledge of cannabis was developed and piloted in 7th grade and 9th grade students. Future studies are required to test usability and validity of the CKAT in other contexts.

Exploring gender differences in HIV-related stigma and social support in a low-resource setting: A qualitative study in the Dominican Republic

HIV-related stigma can affect health by compromising coping and social support. Gender differences in stigma experiences and social support are underexplored, particularly in the Caribbean. We conducted semi-structured interviews (N = 32) with patients at two HIV clinics in the Dominican Republic. Transcripts were coded using qualitative content analysis (deductive and inductive approaches) to identify themes regarding stigma experiences and social support, which were then compared across men and women participants to identify gender differences. While both men and women described experienced stigma, including verbal abuse, men's experience of stigma were subtler and women described outright rejection and instances of physical violence, including intimate partner violence. Both men and women described job discrimination, but women described severe disempowerment as well as permanent loss of income and/or employment whereas men described temporary changes in employment and /or decrease in income. Men and women described modifying behavior due to anticipated stigma, but only women discussed isolating themselves and discomfort taking HIV medication in front of others. Regarding internalized stigma, both men and women described shame, guilt, and depression over their HIV status, though these experiences were more common among women. Women's experiences prevented health care seeking and included suicidality, while men sometimes blamed women for their HIV status and expressed a desire to "move on" and "look ahead." Both men and women described receiving financial support from family and friends, community support from neighbors, governmental support, and support from other people living with HIV. Women most frequently discussed receiving support from family and friends and using religiosity to cope, whereas men referenced general family support and government benefits and were less forthcoming about personal relationships and social networks, oftentimes not disclosing HIV status to others. The social context of HIV-related stigma affects women and men differently with physical and mental health impacts and may require distinct mitigation approaches.

The Perceived Impact of Iron Deficiency and Iron Therapy Preference in Exercising Females of Reproductive Age: A Cross-Sectional Survey Study

Background

Patient perceptions of iron deficiency and efficacy of iron therapy may differ from the interpretations of doctors. Qualitative investigation at an individual level related may help define patient expectations and therapeutic targets. Therefore, we aimed to explore this concept in exercising females of reproductive age.

Methods

Exercising females (n = 403) who either (a) were currently experiencing iron deficiency, or (b) have experienced iron deficiency in the past were included. A survey comprising open-ended text response questions explored three 'domains': (1) the impact of iron deficiency, (2) the impact of iron tablet supplementation (where applicable), and (3) the impact of iron infusion treatment (where applicable). Questions were asked about training, performance, and recovery from exercise. Survey responses were coded according to their content, and sentiment analysis was conducted to assess responses as positive, negative, or neutral.

Results

Exercising females showed negative sentiment toward iron deficiency symptoms (mean range = -0.94 to -0.81), with perception that fatigue significantly impacts performance and recovery. Iron therapies were perceived to improve energy, performance, and recovery time. Participants displayed a strong positive sentiment (mean range = 0.74 to 0.79) toward iron infusion compared to a moderately positive sentiment toward oral iron supplementation (mean range = 0.44 to 0.47), with many participants perceiving that oral iron supplementation had no effect.

Conclusion

In Australia, women prefer an iron infusion in treatment of iron deficiency compared to oral iron.

Age Diversity in Neighborhoods-A Mixed-Methods Approach Examining Older Residents and Community Wellbeing

This paper focuses on age diversity in neighbourhoods and its possible impacts on community wellbeing. The aims of this paper are (a) to investigate whether age diversity in neighbourhoods contribute to older residents' wellbeing and (b) to explore older residents' experiences and views on age diversity in their neighbourhood. These questions are addressed using a mixed-method approach combining survey and interview data and analysis. The data is derived from a survey (n = 420) and 19 semistructured interviews addressed to the older residents of a rental house company located in Eastern Finland. The interview data is analysed using qualitative content analysis. The results of qualitative data indicate that older adults see various benefits in an age-diverse living environment. In the quantitative analysis, we apply multilevel models in our statistical analyses to take both community- and individual-level variation into account. The quantitative results show that older adults living in age-diverse neighbourhoods reported higher community wellbeing. Such association was not found among the younger residents. Overall, our study adds to the understanding of the importance of neighbouring relations on community wellbeing in later life. The results can be utilized when developing age-friendly environments and housing policies at local and national levels.

Development and initial validation of a questionnaire to measure patient experience with oral appliance therapy

STUDY OBJECTIVES

To develop and validate a questionnaire to measure patient experience with oral appliance therapy.

METHODS

The AMEE Guide No. 87 was followed in the development and validation of a patient questionnaire to assess patient experience with oral appliance therapy.

RESULTS

Our search identified 522 articles; 5 of these articles described the use and/or validation of questionnaires to measure changes in symptoms and patient-reported outcomes in the treatment of obstructive sleep apnea. A total of 27 questions were developed. Five patients participated in pilot testing. A final review of the questionnaire was conducted by an expert panel.

CONCLUSIONS

The creation and validation of a questionnaire to assess patient experience with oral appliance therapy may provide new methods for advancing research in the field of dental sleep medicine.

CITATION

Ng ET, Perez-Garcia A, Lagravère-Vich MO. Development and initial validation of a questionnaire to measure patient experience with oral appliance therapy. J Clin Sleep Med. 2023;19(8):1437-1445.

The Influence of Intersectionality on Professional Identity Formation among Underrepresented Pharmacy Students

OBJECTIVE

The objective of this study is to explore professional identity formation (PIF) among student pharmacists from underrepresented groups (URGs).

METHODS

In this qualitative study, 15 student pharmacists from the University of Georgia and Midwestern University Colleges of Pharmacy were recruited for interviews to explore the influence of intersectionality of race, ethnicity, and gender on PIF. Interview data were analyzed using constructivist grounded theory to identify themes and then further analyzed using Crenshaw's theory of intersectionality, namely structural, political, and representational intersectionality.

RESULTS

Intersectionality of identities created situations where participants expressed advantages belonging to certain social categories, while simultaneously being disadvantaged belonging to other social categories. This awareness led to strategies to overcome these collective obstacles for themselves and their communities. Participants then described ways to shift perceptions of how society depicts pharmacists and the pharmacy profession. The results depict these processes and how intersectionality influences PIF for URG student pharmacists.

CONCLUSION

The sociocultural aspects of race, ethnicity, and gender influence the PIF of student pharmacists who belong to URGs. Intersectionality helps us better understand the ways in which inequality compounds itself, and this results in URG student pharmacists creating opportunities for belongingness and representation. Resultantly, URGs create opportunities for inclusivity and representation. To continue to facilitate this it is essential for educators and university systems to promote ways to foster and incorporate PIF in student pharmacists.

'It feels smaller now': The impact of the COVID-19 lockdown on apartment residents and their living environment - A longitudinal study

Introduction

The COVID-19 pandemic and associated lockdown restrictions prolonged residents' exposure to their home environment. The impact of lockdowns could be heightened for apartment residents as they typically have smaller, less versatile homes, and share communal and circulation spaces. This study examined changes in apartment residents' perceptions and experiences of their dwelling before and after the Australian COVID-19 national lockdown.

Methods

Participants consisted of 214 Australian adults who completed a survey on apartment living between 2017 and 2019 and a follow-up survey in 2020. Questions focused on residents' perceptions of their dwelling design, apartment living experiences, and personal life events/changes due to the pandemic. Differences between pre- and post-lockdown periods were assessed via paired sample t-tests. The lived experience of a subset of residents (n = 91) following lockdown was also assessed using qualitative content analysis of free-text responses to an open-ended survey item.

Results

Compared to the pre-pandemic period, after the lockdown residents reported less satisfaction with the amount/layout of their apartment space and private open space (e.g., balconies or courtyards). Increased noise annoyance from indoor and outdoor noise sources was also reported, however disputes with neighbours decreased. The qualitative content analysis highlighted a complex interplay of personal, social and environmental impacts of the pandemic on residents.

Conclusions

Findings suggest an increased 'dose' of the apartment facilitated by stay-at-home orders negatively influenced residents' apartment perceptions. Design strategies that maximise spacious, flexible dwelling layouts with health-promoting elements (e.g., enhanced natural light/ventilation and private open space) are recommended to promote healthy and restorative living environments for apartment residents.